Disparities in healthcare expenditures according to economic status in cancer patients undergoing end-of-life care

Abstract

Backgrounds A desire for better outcome influences cancer patients’ willingness to pay. Whilst cancer-related costs are known to have a u-shaped distribution, the actual level of healthcare utilized by patients may vary depending on income and ability to pay. This study examined patterns of healthcare expenditures in the last year of life in patients with gastric, colorectal, lung, and liver cancer and analyzed whether differences exist in the level of end-of-life costs for cancer care according to economic status. Methods This study is a retrospective cohort study which used data from the Korean National Elderly Sampled Cohort, 2002 to 2015. End-of-life was defined as 1 year before death. Economic status was classified into three categorical variables according to the level of insurance premium (quantiles). The relationship between the dependent and independent variables were analyzed using multiple gamma regression based on the generalized estimated equation (GEE) model. Results This study included 3083 cancer patients, in which total healthcare expenditure was highest in the high-income group. End-of-life costs increased the most in the last 3 months of life. Compared to individuals in the ‘middle’ economic status group, those in the ‘high’ economic status group (RR 1.095, 95% CI 1.044–1.149) were likely to spend higher amounts. The percentage of individuals visiting a general hospital was highest in the ‘high’ economic status group, followed by the ‘middle’ and ‘low’ economic status groups. Conclusion Healthcare costs for cancer care increased at end-of-life in Korea. Patients of higher economic status tended to spender higher amounts of end-of-life costs for cancer care. Further in-depth studies are needed considering that end-of-life medical costs constitute a large proportion of overall expenditures. This study offers insight by showing that expenditures for cancer care tend to increase noticeably in the last 3 months of life and that differences exist in the amount spent according economic status.

Economic Burden of Cancer for the First Five Years after Cancer Diagnosis in Patients with Human Immunodeficiency Virus in Korea

“…A previous study also suggested an increased cancer burden in patients with HIV infection, and that the burden of non-AIDS-defining cancer would be increased and that of AIDS-defining cancer would be decreased due to aging and improved therapy for HIV infection [24]. In this study, the number of HIV patients with cancer was 235 in 2018 to Previous studies on the general population reported increased medical costs in the final months of the life of patients [16,[18][19][20]. In Korea, cost-sharing systems to reduce out-of-pocket medical expenses for cancer are available for five years after cancer diagnosis; hence, there are difficulties in estimating the medical cost of cancer after five years of diagnosis.…”

“…Previous studies on the general population reported increased medical costs in the final months of the life of patients [ 16 , 18 - 20 ]. In Korea, cost-sharing systems to reduce out-of-pocket medical expenses for cancer are available for five years after cancer diagnosis; hence, there are difficulties in estimating the medical cost of cancer after five years of diagnosis.…”

“…Thus, the cost of cancer care continuum according to the phases of cancer case has been estimated [13][14][15]. Regarding endof-life care for cancer, studies have considered several time Month cut-offs, such as 3, 6, or 12 months before death [13][14][15][16][17][18][19][20]. The initial and terminal phases had a higher burden of medical costs than that of the continuing phase, showing an overall U-shaped pattern [13,15].…”

Cancer care patterns in South Korea: Types of hospital where patients receive care and outcomes using national health insurance claims data

“…This is because economic accessibility can be improved by reducing patients' out‐of‐pocket burden. With the expectation of receiving high‐quality cancer treatment, patients desire to visit high‐volume or capital area hospitals from the perspective of medical use, resulting in an impact on overall cancer care such as excessive end‐of‐life medical expenditure 10–13 . According to the 2021 Health Insurance Review and Assessment statistics, more than half of cancer treatment medical costs occur in capital areas (62.4%).…”

“…With the expectation of receiving high‐quality cancer treatment, patients desire to visit high‐volume or capital area hospitals from the perspective of medical use, resulting in an impact on overall cancer care such as excessive end‐of‐life medical expenditure. 10 , 11 , 12 , 13 According to the 2021 Health Insurance Review and Assessment statistics, more than half of cancer treatment medical costs occur in capital areas (62.4%). Additionally, 68.2% of cancer‐related medical expenses are spent at tertiary hospitals.…”